Clozapine tolerance to sedation, hypotension and seizure risk falls quickly once doses are missed. If a patient has missed clozapine for more than 48 hours, restarting at the previous dose risks marked hypotension, collapse and seizures. The standard approach is to re-titrate from a low starting dose, usually 12.5 mg once or twice daily, and build up again, often faster than the first time. Check the local monitoring rules too, since a long break may reset the blood test schedule.
- Ask about missed clozapine doses at every admission, review and relapse presentation.
- Re-titrate from a low dose if more than 48 hours have been missed.
- Check blood pressure and pulse during the re-titration.
- Check whether the break means neutrophil monitoring must restart at a more frequent schedule.
Why it matters
Unplanned breaks are common during admissions to medical wards, where staff may restart the full dose unaware of the risk.
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